1
Q
mood disorder facts
A
- Lifetime prevalence o 4-11% Canadian studies - Gender differences o Females 2x as likely to have mood disorders - Age and culture o Mood disorders are fundamentally similar in kids and adults • Typical onset = adolescent • Depression seen in all age groups • Characterized by irritability in kids o Prevalence similar across subcultures
2
Q
mdd - Serious disturbances of mood and affect
A
o V depressed mood state
o Anhedonia – loss of pleasure/interest, affecting many or most areas of life
• Nothing matters anymore, very detached
o Need 1 of above symptoms
o Thoughts of death or suicide
3
Q
- Cognitive disturbance and negative cognitions
A
o Diminished ability to think or concentrate o Indecisiveness o Feelings of worthlessness o Excessive or inappropriate guilt o Lots of worry
4
Q
- Serious somatic symptoms
A
o Appetite disturbances with wright loss or gain
o Sleep disturbances (insomnia or hypersomnia)
o Lack of energy and/or easily fatigued
o Psychomotor agitation/slowing
5
Q
- Course and form of MDD
A
o Reps a change from previous functioning, causing significant distress or impairment in functioning
o Symptoms are present all day, nearly every day for the same 2 week period
o 2 weeks – 9 months
• Present all day nearly every day
o Single episode highly unusual
o Recurrent episodes are more common
o Sometimes infants can exhibit symptoms → caregiver has symptoms and don’t give the care kid needs
6
Q
pdd
A
o Continues for 2+ years o A lot of people say they have been depressed for as long as they can remember o Symptom free for no more than 2mo o Similar symptoms to MDD o More chronic and severe than MDD o May persist unchanged over long periods o Higher rates of co-morbidity o Greater levels of psychopathology o Lots of feelings of hopeless that leads to o Higher rates of suicidality o Less responsive to treatment o Many develop MDD
7
Q
mania
A
- Manic episode
o Severe mood disturbance – usually really elevated
o Cognitive and behavioral symptoms, often psychosis
o Duration: at least 1 week; 2-6mo if untreated
o High risk that symptoms will be self destructive - Hypomanic episode
o Similar symptoms to mania
o Less severe
o Doesn’t cause marked impairment
o Symptoms of shorter duration – only a few days
o Extreme about of heightened activity and energy compressed into a short period
8
Q
manic episode
A
- Severe mood disturbance with increased energy and activity
o Abnormally and persistently elevated, expansive mood or irritable mood
o Persistently increased goal-directed activity or energy - Cooccuring symptoms
o Mood and cog:
• Inflated self esteem or grandiosity
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility
• Often includes psychosis
o Behavior and psychomotor:
• Decreased need for sleep
• More talkative than usual or pressure to keep talking
• Excessive involvement in pleasurable activities (with high potential for painful consequences
9
Q
bipolar 1
A
- Overview and defining features:
- Alternations between full manic and major depressive episodes
o Meets full criteria for both - May show evidence of psychosis
- Suicide is a common consequence
- Facts and stats:
- Average age of onset is 18
- Chronic
10
Q
bipolar 2
A
o Alternations between hypomanic episodes and major depressive episodes o Meets criteria for each o May include psychotic features o High risk of suicide - Facts and stats: o Average age of onset is 22 o Can begin in childhood/adolescence o Tends to be chronic o 10-13% progress to bipolar I o one of most debilitating disorders
11
Q
cyclothymic disorder
A
- More chronic but less severe version of bipolar
- Hypomanic episodes alternate with depressive episodes (not full mdd) → some symptoms but not all
o Numerous alternations
o Pattern for almost at least 2y – 1 for kids and teens
o Symptom free for no more than 2mo - High risk for developing bipolar
- Subtypes
o Predominance of mild depressive symptoms
o Predominance of hypomanic symptoms
o Equal distribution of both mild depressive symptoms and hypomanic symptoms
12
Q
Premenstrual dysphoric disorder
A
- To enable women to get help and to correctly diagnose
- Severe mood liability (moment to moment shifts in mood) , irritability, anxiety/depressive symptoms occurring during the premenstrual phase of the menstrual cycle
o Andedonia
o Cant concentrate
o Fatigue
o Hyper/insomnia - Also
o Sense of being overwhelmed or out of control
o Breast tenderness or swelling, joint or muscle pain, sensation of bloating or weight gain
o Change in appetite, overeating, specific food cravings - Disturbance is
o Not an exacerbation of another depressive, anxiety or personality disorder
o Must be present during most cycles for a year
o Confirmed by prospective dauly ratings of symptoms
o Must cause distress or interfere with work, school, social, relationships - Remit around or following onset of menses
13
Q
Disruptive mood dysregulation
A
- Frequent, severe temper outburst or tantrums
o Not age appropriate, out of proportion - Chronic irritability, aggression, moodiness
- Extreme difficulty controlling emotions
- Severe relationship difficulties
- On your way to having a different disorder in adulthood
- Facts and stats:
o New dsm diagnosis
o Aimed at increasing diagnostic precision
o Many kids misdiagnosed resulting in improper treatment
o Must be evident by age 10
o Must occur in at least 2 settings
o Must be happening for a long period of time
14
Q
Familial and genetic influences
A
- Genetic research findings
o High concordance rate for identical twins
o Stronger genetic contributions for severe mood disorders
o Greater genetic vulnerability for females
o Polarity: mixed evidence on type of vulnerability inherited
o Serotonin transporter gene
• ‘s’ allele associated with vulnerability to depression and brain volume differences - Joint heritability of anxiety and depression
o Some evidence that same genetic factors may contribute to anxiety and depression
15
Q
Neurobiological influences
A
- Neurotransmitters research findings
o Permissive hypothesis
• Low serotonin levels permit other neurotransmitters to become dysregulated
• Low levels of 5HT implicated in depression but only in relation to other neurotransmitters
o Now NE levels: found in bipolar and severe unipolar depression
o NE, DA, 5HT are theorized to play a role in manic episodes - EEG andMRI/fMRI stidies of mood disorders
o ID of characteristic patterns of prefrontal cortex activation
• Associated with depression
• Increased activation in right anterior
• Decreased activation in left anterior
• Associated with bipolar
• Increased activation in left anterior which predicts onset
o ID of structural differences and neural circuits involved in the cognitive-emotional deficits associated with depression
• ‘s’ allele of 5HT transporter gene associated with smaller amygdala and cingulate cortex volume resulting in deficits
• amygdala works too well and cortex doesn’t buffer – amygdala adds too much meaning to emotional events
• fuels negative thinking
16
Q
Psychological dimensions
A
- The role of stress in mood disorders
o Stress and trauma are strongly related to the onset and relapse of mood disorders
o Severe life stress, especially
• Is associated with onset of both depression and bipolar disorder
• Predicts poorer response treatment
o Attributed meaning seems to be critical - Learned helplessness theory of depression
o Related to lack of perceived control over life events
• Depressive attributional style
• Interacts with initial response to stress, anxiety
• Leads to hopelessness related and negative cognitions and eventually to depression
• Nothing I can do to make life better, I am hopeless so I do nothing
• Everything is my fault
17
Q
Becks cognitive theory of depression
A
- Cog behave therapy based on this theory
- Depression
o Defined as a tendancy to interpret life events negatively
• Causes depressed persons to apply cognitive distortions to life situations that lea to a negative mood
• Negative self talk
o Cognitive distortions
• All or nothing thinking
• Over generalization
• Magnification or castophizing
• Jumping to conclusions
o Depressive triad
• Tendency to think negatively about oneself, the world, the future
• Can lead to hopelessness, depression
18
Q
Social and cultural dimensions
A
- Marriage and interpersonal relationships
o Marital dissatisfaction is strongly related to depression
• This link is particularly strong in males - Gender imbalances
o Occur across all mood disorders except bipolar disorders
o Females tend to internalize more and males are more externalized with thoughts
o Gender imbalance likely is partly due to socialization (ie perceived uncontrollability) - Social support
o Extent of social support is related to depression
• Lack of social support predicts late onset depression
• Substantial social support predicts recovery from depression
19
Q
Overview: Mood disorder treatment
A
- Biological treatment
o Use of medications that act on neurotransmitter systems (5HT DA, NE)
o Electro-convulsive treatment (ETC)
o Transcranial magnetic stimulation (TMS) - Psychological treatment
o Cognitive behavioral tharapy
o Interpersonal therapy
20
Q
Depressive disorders treatment
A
- SSRIs o Fluoxetine (Prozac): most popular o Block presynaptic reuptake of serotonin o Negative side effects common • Sexual dysfunction/low desire o 50-70% effectiveness - SNRIs o Venlafaxine (Effexor) o Block presynaptic reuptake of serotonin and norepinephrine o Addresses co-occuring anxiety o Fewer side effects o Dopamine energizes some, helpful for people that are becoming veggie like
21
Q
Depressive disorders treatment: antidepressant medications
A
- Trycyclics:
o Imipramine (tonfranil) and amitriptyline (elavil)
o Initially blocks reuptake of
• NE and other neurotransmitters
o Negative side effects are common
• Usually pretty bad, 40% stop taking as a result - Monoamine oxidase (mao) inhibitors
o Blocks MAO (enzyme that breaks down 5HT and NE)
o Fewer effects that tricyclic
o Potentially fatal interactions, must avoid
• Tyramine containing foods: beer, red wine, cheese
• Cold medications - Other issues
o Efficacy issues and negative side effects in special populations
• Children
• Elderly
• Potential health effects like heart, especially in kids
o Approximately 40-50% fail to improve
o Preventing relapse and maintaining benefits may be more crucial than recovery
22
Q
Bipolar disorder treatment: lithium
A
- Common salt occurring in the natural environment
- Primary treatment for BD
- Narrow therapeutic window
o Too little – ineffective
o Too much – toxic, lethal
o Effective with 50%
o High rates of relapse: approx. 70% - Mania makes you feel on top of the world sometimes and the drug makes it stop so they stop taking drug
- Think it may work on many NTs, endocrine system
- Deactivates enzyme that is theorized to affect biological thoughts/circadian rhythms
- Glutamate antagonist
23
Q
Mood disorders treatment: ETC and TMS
A
- Electroconvulsive therapy
o Apply a brief electrical current
o Temporary seizures
o 6-10 treatments = usual course of treatment
o Indicated for severe depression: 50-70% not responding to other medication to improve
o Relapse is common: 60% - Transcranial magnetic simulation
o Electromagnetic stimulation of the brain
o Causes stimulation of neurons in the cortex
o Approved by health Canada: 2002
24
Q
Mood disorder treatment: psychological intervention
A
- Cognitive therapy:
o Identify thinking errors; substitute more adaptive thoughts
o Correct cognitive errors and negative cognitive schemas
o Also includes behavioral component - Behavioral activation
o Helps depressed persons make increased contact with reinforcing events - Interpersonal psychotherapy
o Addressed interpersonal issues in relationships
• Life stressors, loss, social skills deficit
• Helping us work on relationships will help with depression because it is often based in our relationships
25
Mood disorder treatment: psychological intervention
Cognitive therapy:
o Identify thinking errors; substitute more adaptive thoughts
o Correct cognitive errors and negative cognitive schemas
o Also includes behavioral component
- Behavioral activation
o Helps depressed persons make increased contact with reinforcing events
- Interpersonal psychotherapy
o Addressed interpersonal issues in relationships
• Life stressors, loss, social skills deficit
• Helping us work on relationships will help with depression because it is often based in our relationships
26
Suicidal behavior
- Suicide rates in Canada
o Highest in alberta, quebec, northwest territories
o Lowest in newfoundland and labrador
o Highest rates among aboriginal people
o Increasing rates, particularily in young
- Gender differences
o Males have higher completion rates than females
o Females attempt suicide more often than makes
27
Suicide: risk factors
- Family history of suicide
- Low serotonin levels
- Preexisting psychological disorders
- Alcohol use/abuse
- Past suicidal attempts
- Shameful/humiliating stressor
- Publicity about suicide – especially in youth
- Serious illness, loss of a spouse – especially in elderly men
28
Suicide assessment and treatment
```
- Importance of a thorough risk assessment
o Previous attempts
o Recent stressful life events
o Ideation vs intent
o Plan, method, means and access
- No suicide contract (controversial)
- Problem solving therapy
- CBT
- Stress reduction
- Hospitalization
```
29
Potential warning signs of suicide
- Verbal suicide threats or statements
- Previous suicide attempt
- Risk taking, reckless behavior
- Final arrangements – giving away prized possessions, making peace, tying up loose ends
- Separation from loved ones, significant others
- Themes in writing or art about death, depression or suicide
- Talk of wanting to die
- Chronic depression; prolonged grief after a loss
- Unusual purchases – gun, rope, medications gathering of pills or poisons
- Unusual sadness, discouragement and loneliness
Abnormal Behavior
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